Changes in the customer’s medical insurance premium amounts may affect the customer’s SOC for ALTCS services (MA1201C).

When a parent or other relative is living with a child and is the child’s main caretaker, the child must have minimum essential coverage for the person to qualify for the Adult group (MA518).

A customer is no longer eligible for BCCTP when she has creditable health insurance coverage, unless she qualifies for an exception (MA515).

A customer is no longer eligible for KidsCare when he or she has creditable health insurance coverage (MA515). 

NOTE          When a person chooses to end a child’s creditable health insurance coverage, the child cannot qualify for KidsCare for 90 days.  The 90 days begins the day after the creditable coverage ends unless the customer meets an exception.  (MA516)

Health insurance coverage as defined under the Health Insurance Portability and Accountability Act (HIPAA).

Examples of creditable coverage include:

·        Medicare;

·        Group health plans including Qualified Health Plans;

·        Health insurance coverage through a hospital or medical service policy, certificate or plan contract; or

·        Armed forces insurance (i.e., TriCare).

The following types of policies are considered non-creditable coverage:

·        Coverage only for accidents (including accidental death and dismemberment);

·        Liability insurance, including general liability and automobile liability insurance;

·        Free medical clinics at a work site;

·        Benefits with limited scope such as dental benefits, vision benefits or long term care benefits;

·        Coverage for a specific disease or illness (including cancer policies);

·        Insurance that pays a set amount a day when the person is hospitalized or unable to work.

Means any of the following kinds of health insurance coverage:

·        Full AHCCCS Medical Assistance benefits;

·        Medicare Part A;

·        TriCare for Life;

·        Veterans health program;

·        Government health plan for Peace Corps volunteers;

·        Group and Individual health plans, including Qualified Health Plans purchased on the Federally Facilitated Marketplace;

·        Employer-sponsored coverage; or

·        Other health benefits coverage, such as a State health benefits risk pool.

Minimum Essential Coverage does NOT include:

·        Coverage only for accident or disability income insurance;

·        Liability insurance, including general liability insurance and automobile liability insurance;

·        Workers’ compensation or similar insurance;

·        Automobile medical payment insurance;

·        Coverage for on-site medical clinics;

·        Dental- or vision-only benefits;

·        Coverage only for long-term care services;

·        Coverage only for a specified disease or illness; or

·        Hospital indemnity or other fixed indemnity insurance.

The later of the first day of the month in which the change:

·        Took place; or

·        Was reported to AHCCCS.

The first day of the month after the change that allows for adverse action rules.

42 CFR 435.725(c)(4)(i)

42 CFR 435.726(c)(4)(i)

42 CFR 435.916

AAC R9-28-410(C)

AAC R9-28-411(A)(1)

42 CFR 435.916

ARS 36-2901.05

AAC R9-22-2003(A)(5)

AAC R9-22-2005(D)(1)

42 CFR 435.916

42 CFR 435.119(c)

42 CFR 457.310(b)(2)(ii)

ARS 36-2983(G)(2)

AAC R9-31-303